Individual
DR. KEVIN D WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3365 S 103RD ST, GREENWAY MEDICAL CENTER, MILWAUKEE, WI 53227-4161
(414) 604-7501
(414) 604-7506
Mailing address
3365 S 103RD ST, GREENWAY MEDICAL CENTER, MILWAUKEE, WI 53227-4161
(414) 604-7501
(414) 604-7506
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
41518-020
WI
2080S0010X
Pediatric Sports Medicine Physician
Primary
41518-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316975089
—
WI
Enumeration date
06/29/2006
Last updated
02/15/2013
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